ENROLLMENT AGREEMENT



ENROLLMENT AGREEMENT

Medisense

11315 Cranston Drive

Peyton, CO 80831

(719) 291-1134

Fax (719) 597-0114

Approved and Regulated by the Colorado Department of Higher Education,

Private Occupational School Board

General Information Date_____________

Student’s Name_______________________ Address___________________________________________

Street City State Zip

Home Phone_______________________________ Cell Phone_______________________________

Email Address______________________________ SS# for Transcript_____________________________

Stand Alone Course (DPOS requirement)

Course: AAPC’s Professional Medical Coding Curriculum (PMCC) Medical Coding Training: CPC

Start Date: July 17, 2021 Estimated Completion: November 27, 2021

Saturday mornings: 8:30 a.m. – 12:30 p.m. Mountain Time via Live Virtual Classroom

Type of Instruction Hours of Instruction Number of Lessons

Classroom – live virtual 80 Hours 20 Lessons

Tuition & Materials

Tuition $___1800.00___

(If you are already a member of the AAPC,

AAPC Membership $_____90.00___ your deposit will be $825 instead of $915)

(Non-refundable) Must provide AAPC ID#________________

Books/Supplies/Tools $____500.00___

(Non-refundable)

Examination $____325.00___

(Non-refundable)

Total Cost of Program $_ 2,715.00 ___

Schedule of Payments (following installment option available)

Deposit $____915.00____ Date________________ BALANCE DUE $_____1800.00_____

Date Due – 08/17/2021 $___450.00___ Recd____________

Date Due – 09/17/2021 $___450.00___ Recd____________

Date Due – 10/17/2021 $___450.00___ Recd____________

Date Due – 11/17/2021 $___450.00___ Recd____________

Payment Options: ________ Check or Money Order (enclose check/Money Order with your signed Enrollment Agreement)

(Please initial) ________ Debit/Credit card via: PayPal or Merchant Account (for MyCAA only) (Please circle one.) (For this option: Upon receipt of your signed Enrollment Agreement, I will send you an email request for payment with instructions.)

The cost of credit extended is included in the price quoted for the goods and services.

By signing below, the student agrees to pay Medisense (“school”) the total stated for tuition & materials. The school agrees to provide the occupational training in accordance with the provisions of the school’s current Catalog Volume No. 27 dated Fall 2021 (“Catalog”). Payment of all moneys due shall be a condition of continuing enrollment. Upon satisfactory completion of all academic and skill requirements and when all financial obligations to the school have been met the school will award the Certificate of Completion to the student. The student and school understand that this Enrollment, WHICH INCLUDES THE REFUND POLICY, may not be amended except in writing and signed by both parties.

Entrance Requirements

The school does not discriminate based on race, sex, religion, ethnic origin, or disability.

Prospective students must have a high school diploma or equivalency diploma to be accepted for enrollment. If applicants are beyond the age of compulsory school attendance in Colorado and do not possess a diploma or equivalency diploma, they may complete an ability to benefit test approved by the Colorado Department of Higher Education. The school does not administer the test, but will provide information on availability when requested.

Student Complaints

Attempting to resolve any issue with the School first is strongly encouraged. Student Complaints may be brought to the attention of the Division of Private Occupational Schools online at , 303-862-3001. There is a two-year statute of limitations for the Division to take action on a student complaint (from student’s late date of attendance).

Refund Policy

Students not accepted to the school are entitled to all moneys paid. Students who cancel this contract by notifying the school within three (3) business days are entitled to a full refund of all tuition and fees paid. Students, who withdraw after three (3) business days, but before commencement of classes, are entitled to a full refund of all tuition paid except the maximum cancellation charge of $150.00 or 25% of the contract price, whichever is less. Certain fees are non-refundable and clearly identified. In the case of students withdrawing after commencement of classes, the school will retain a cancellation charge plus a percentage of tuition and fees, which is based on the percentage of contact hours attended (for those taking the course via virtual classroom as distance education: “based on the percentage of no. of lessons completed”)*, as described in the table below. The refund is based on the official date of termination or withdrawal.

Refund Table

|Student is entitled to upon withdrawal/termination |Refund |

|Within first 10% of program *(Lessons 1 – 2) |90% less cancellation charge |

|After 10% but within first 25% of program *(Lessons 3 – 5) |75% less cancellation charge |

|After 25% but within first 50% of program *(Lessons 6 – 10) |50% less cancellation charge |

|After 50% but within first 75% of program *(Lessons 11 – 15) |25% less cancellation charge |

|After 75% *(Lesson 16) [if paid in full, cancellation charge is not applicable] |NO Refund |

1. The student may cancel this contract at any time prior to midnight of the third business day after signing this contract.

2. All refunds will be made within 30 days from the date of termination. The official date of termination or withdrawal of a student shall be determined in the following manner:

a. The date on which the school receives notice of the student’s intention to discontinue the

training program; or

b. The date on which the student violates published school policy, which provides for termination;

c. Should a student fail to return from an excused leave of absence, the effective date of termination

for a student on an extended leave of absence or a leave of absence is the earlier of the date the

school determines the student is not returning or the day following the expected return date.

3. The student will receive a full refund of tuition & fees paid if the school discontinues a program/stand alone course within a period of time a student could have reasonably completed it, except that this provision shall not apply in the event the school ceases operation.

4. The policy for granting credit for previous training shall not impact the refund policy.

I HAVE RECEIVED A COPY OF THIS ENROLLMENT AGREEMENT AND A CURRENT SCHOOL CATALOG.

_____________________________ ________ _____________________________ ________

Student Signature Date School’s Approved In-state Agent Date

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